Browsing by Author "Semwanga Rwashana, Agnes"

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    Advancing the application of systems thinking in health: understanding the dynamics of neonatal mortality in Uganda
    (Health Research Policy and Systems, 2014) Semwanga Rwashana, Agnes; Nakubulwa, Sarah; Nakakeeto-Kijjambu, Margaret; Adam, Taghreed
    Of the three million newborns that die each year, Uganda ranks fifth highest in neonatal mortality rates, with 43,000 neonatal deaths each year. Despite child survival and safe motherhood programmes towards reducing child mortality, insufficient attention has been given to this critical first month of life. There is urgent need to innovatively employ alternative solutions that take into account the intricate complexities of neonatal health and the health systems. In this paper, we set out to empirically contribute to understanding the causes of the stagnating neonatal mortality by applying a systems thinking approach to explore the dynamics arising from the neonatal health complexity and non-linearity and its interplay with health systems factors, using Uganda as a case study. Methods: Literature reviews and interviews were conducted in two divisions of Kampala district with high neonatal mortality rates with mothers at antenatal clinics and at home, village health workers, community leaders, healthcare decision and policy makers, and frontline health workers from both public and private health facilities. Data analysis and brainstorming sessions were used to develop causal loop diagrams (CLDs) depicting the causes of neonatal mortality, which were validated by local and international stakeholders. Results: We developed two CLDs for demand and supply side issues, depicting the range of factors associated with neonatal mortality such as maternal health, level of awareness of maternal and newborn health, and availability and quality of health services, among others. Further, the reinforcing and balancing feedback loops that resulted from this complexity were also examined. The potential high leverage points include special gender considerations to ensure that girls receive essential education, thereby increasing maternal literacy rates, improved socioeconomic status enabling mothers to keep healthy and utilise health services, improved supervision, and internal audits at the health facilities as well as addressing the gaps in resources (human, logistics, and drugs). Conclusions: Synthesis of theoretical concepts through CLDs facilitated our understanding and interpretation of the interactions and feedback loops that contributed to the stagnant neonatal mortality rates in Uganda, which is the first step towards discussing and exploring the potential strategies and their likely impact.
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    Antecedents and Dynamics for Strategic Alignment of Health Information Systems in Uganda
    (The Electronic Journal of Information Systems in Developing Countries, 2014) Adie Odit, Mary Celestine; Semwanga Rwashana, Agnes; Mayoka Kituyi, Geoffrey
    Health Information Systems (HIS) in Uganda always fail to achieve the organizational objectives and yet little research has been conducted to study the strategic alignment of HIS in the country. This study therefore set out to examine the antecedents and dynamics that influence strategic alignment of HIS in Uganda with the aim of adequately addressing the complex IS design issues. A total of 296 respondents were purposively selected from 39 health facilities across the country to participate in the survey. Data was analyzed using descriptive statistics. Findings from the study revealed that HIS are used to locate substitute sources for medical commodities, reduce costs of handling orders as well as minimize uncertainty in ordering lead time. In addition, HIS provide information to clients, add value to existing health services and are used to target health service needs with accuracy as well as identify groups of clients whose needs are not being met. HIS are used to minimize the cost of designing services, adding features to existing services and population grouping services at the health unit level. In the area of internal health facility efficiency, HIS help in ensuring efficiency and enable informed decision making, provide efficiency in internal meetings and discussions, co-ordination among facility departments, and provide good evaluation on annual budget. Further, HIS are used by health workers to provide evaluation on capital, maximize organizational performance, population coverage and strategic planning efficiency. Despite the above, the study revealed that health units do not have standards, frameworks and policies for the strategic alignment of HIS and the funding to support them. For better alignment of HIS, there should be proper planning and training of health workers on the importance of strategic alignment of HIS. Further, health facilities should be encouraged to adopt electronic information systems to improve their efficiency and effectiveness. There should also be policies, frameworks and or standards for guiding strategic alignment of Health Information Systems in health facilities.
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    Household Food Security Policy Analysis: A System Dynamics Perspective
    (International Journal of Scientific & Technology Research, 2016) Guma, Isdore Paterson; Semwanga Rwashana, Agnes; Oyo, Benedict
    Household food security (FS) is complex and requires multiple stakeholder intervention. Systemic approach aids st akeholders to understand the mechanisms and feedback between complexities in food security providing effective decision making as global resource cons umption continues to grow. The study investigated food security challenges and a system dynamics model was developed for evaluating policies and intervention strategies for better livelihood at household level. Dynamic synthesis methodology, questionnaires and interview guide were used to unea rth food security challenges faced by households. A causal loop diag ram was drawn. The model demonstrates a balance between food stock, seeds preserved, seeds for sale and consumption from crop harvest throughout the food cycles. This research makes contribution to the literature by evaluating dynamic synthesis methodology and FS policy discussions from a feedback point of view.
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    A System Dynamics Model of Land-use Change for Climate Change Adaptation: The Case of Uganda
    (Scitepress science and technology publications, 2021) Guma, Isdore Paterson; Semwanga Rwashana, Agnes; Oyo, Benedict
    System dynamics models in land use change are useful tools for understanding the cause and effect of land use changes, assessing the impacts of land use systems on the environment, and supports land use planning and policy dimensions. Several studies have used different methods to examine the drivers of land-use change in understanding the interactions of land-use change as a result of human activities. However, much less work has been undertaken to model the future of a suite of ecosystem services in a holistic way. These studies have been conducted with minimum emphasis on the systemic structures or feedback processes of land-use decisions. A system dynamics model will be used to model ecosystem services to understand complex interactions using dynamic synthesis methodology. Questionnaires and interviews will be used for data collection. The study will explore viable policies for optimal land use to mitigate the degree of future climate change and risks. Projections of future resource requirements and environmental stress are alarming as a result of poorly planned economic development. Unless significant measures are taken to incorporate environmental concerns, the situation is likely to worsen in the future. Modeling complex natural-human systems remains an important research area.